<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 203903508
Report Date: 08/23/2019
Date Signed: 08/23/2019 03:40:29 PM

COMPREHENSIVE INSPECTION
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:VILLAGOMEZ, LUZ MARIA FAMILY CHILD CAREFACILITY NUMBER:
203903508
ADMINISTRATOR:VILLAGOMEZ, LUZ MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 674-7384
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY:14CENSUS: 4DATE:
08/23/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Luz Maria VillagomezTIME COMPLETED:
04:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Juvenal Moctezuma conducted an unannounced Annual/Random inspection and met with Licensee, Luz Maria Villagomez and assistant. LPA explained the reason of the inspection and a tour of the home was conducted both inside and outside. LPA observed licensee caring for 4 children of whom 1 was her grandchild. Licensee stated that 2 other children were at school.

Licensee stated that children have access to the playroom, 1 bathroom, and part of her backyard. LPA observed plenty of age appropriate toys in the play room like small cubbies, 2 cribs, small couches, and small tables and chairs. LPAs Observed that the play room was clean and free of toxins. Licensee stated that children don't have access to the rest of her house. Licensee stated that the backyard is currently off limits since she is having someone come over to paint her fence. There are cans of paint along with a machine out in the backyard. LPA advised licensee to call CCL next time she is doing something to her house that require outside workers to come to her house.

The knives are stored in licensees kitchen which is off limits to children. LPA observed that licensee had stored her medications and vitamins in a drawer that was accessible to children in care. The cleaning supplies/toxins are stored up high in a cabinet. LPA spoke about the safe sleep regulations that will take affect this year (2019) with the licensee and reminded her to not store anything inside the cribs and playpens. LPA also provided licensee with a safe sleep brochure and the new lead brochure.

The bathroom was found clean and free of toxins during the inspection. Licensee stated that the backyard is currently off limits to children in care. The backyard has a fence that goes all around. LPA observed plenty of age appropriate toys and shade area. Licensee has 1 dog in the backyard and states that they don't have contact with children in care. Licensee understands responsibility of any action taken by pets involving day care children.

Licensee has a 2A10 BC fire extinguisher. LPA explained to licensee that she needs to get it serviced or replaced yearly. Licensees CPR/First Aid certificate is good until 10/21/2019.
Report continued onto LIC 809-C
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: VILLAGOMEZ, LUZ MARIA FAMILY CHILD CARE
FACILITY NUMBER: 203903508
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/26/2019
Section Cited

1
2
3
4
5
6
7
Carbon monoxide detectors required; inspection
Every family day care home for children shall have one or more carbon monoxide detectors in the facility... This requirement was not met as evidenced by
8
9
10
11
12
13
14
Licensee not having a working Carbon Monoxide detector in the home. This poses an immediate health/safety risk to children in care.
8
9
10
11
12
13
14
Type A
08/26/2019
Section Cited

1
2
3
4
5
6
7
Operation of a Family Child Care Home. Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger to children shall be stored where they are inaccessible to children. This requirement was not met as evidenced by Licensee failing to
8
9
10
11
12
13
14
leave her medication and vitamin bottles in a drawer that's accessible to children in care in the play room. Licensee removed the bottles and stored them up high. This poses an immediate health/safety risk to children in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2019
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: VILLAGOMEZ, LUZ MARIA FAMILY CHILD CARE
FACILITY NUMBER: 203903508
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/30/2019
Section Cited

1
2
3
4
5
6
7
Operation of a Family Child Care Home. All homes shall have a current roster of the children. This requirement was not met as evidenced by: LPA doing file review of the children's roster and interview with licensee that she does not have a children's roster. Licensee stated that she has never had a children's roster.
8
9
10
11
12
13
14
This poses a potential health and safety risk to children in care.
8
9
10
11
12
13
14
Type B
08/30/2019
Section Cited

1
2
3
4
5
6
7
Child's Records. The licensee shall maintain, in each child’s record, the signed and dated notice form LIC 995A, Parents Rights Notice and a copy of the emergency information card required in Section 102417(g) (7). Based on licensee’s interview and missing file/records of child #1 and Child #2. licensee
8
9
10
11
12
13
14
failed to meet the regulation for children’s records. Child #1 and #2 are missing their complete files. Licensee states that she will provide the Licensing forms to the parents and create the children's files. This possess a Potential Health, Safety or Personal Rights Risk to children in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2019
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: VILLAGOMEZ, LUZ MARIA FAMILY CHILD CARE
FACILITY NUMBER: 203903508
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/30/2019
Section Cited

1
2
3
4
5
6
7
Operation of a Family Child Care Home. Each family child care home shall conduct fire drills and disaster drills at least once every six months. The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home. This requirement was not met as
8
9
10
11
12
13
14
evidenced by: Based on interview and records review, licensee failed to produce a fire drill log reflecting current fire drills. This poses a potential risk to the health, safety, or personal rights of children.
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: VILLAGOMEZ, LUZ MARIA FAMILY CHILD CARE
FACILITY NUMBER: 203903508
VISIT DATE: 08/23/2019
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Licensee does not have proof that she has conducted Fire/disaster drills within 6 months. The smoke detector was tested and found in working condition. Licensee does not have a working Carbon Monoxide. Licensee changed the batteries but the Carbon Monoxide detector was not working. Licensee was not able to find Child #1 and Child #2's files. Licensee stated that she was not aware that she ever needed to have a children's roster. Licensee stated that there are no guns or ammunition in the home and LPAs did not observe any bodies of water during todays inspection. Licensee is current with the immunization requirements per SB 792. Mandated Reporter Training AB 1207 was also discussed during todays inspection.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

During todays inspection, The following type A and Type B Deficiencies were observed. Appeal rights were explained and provided to licensee.


Upon receipt of this report, licensee shall post for 30 days and provide copies of this licensing report to parents /guardian of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. Licensee to provide LIC 9224 for each child in care and have each parent sign the form that they have received a copy of the report LIC 809 and LIC 809 D.

This report was translated in Spanish by LPA Moctezuma.

Licensee was reminded that it is her responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov.

LPA observed licensee post the Notice of Site visit.
FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2019
LIC809 (FAS) - (06/04)
Page: 2 of 5